Asthma self-management programmes in a population of Italian children: a multicentric study. Italian Study Group on Asthma Self-Management Programmes.

This study was designed to answer three main questions: 1) Does asthma self-management education reduce asthma morbidity? 2) Are the two programmes "Living With Asthma" and "Open Airways" equally effective in doing so? 3) Is a shortened version of these programmes (4 weeks) as effective as the longer original programme (8 weeks)? Twelve Italian centres of paediatric bronchopneumology selected 312 children with asthma, who were stratified by disease severity, gender and age, and then randomly assigned to an Experimental group which received an educational programme or to a Comparison group, which did not. Of the 312 children selected, 209 (114 Experimental and 95 Comparison) completed the educational protocol and a 1 year follow-up. Data recorded during the last 2 months of follow-up, 10 months after the educational intervention, showed that the Experimental group required significantly fewer emergency treatments: this reduction was more evident in the more severe asthma cases. In the Experimental, but not in the Comparison group, patients with more severe asthma consumed more medications than patients with milder asthma "Open Airways" yielded, in some cases, better results than "Living with Asthma": but a type 2 error is possible. The standard and the shortened programmes proved equally effective. In conclusion, following education, regardless of receiving a short or long educational programme, asthma patients use emergency care services less and use medications more appropriately in comparison with standard care without education. This suggests that short educational programmes can be highly cost-effective in children with asthma.

Perception of bronchoconstriction in chronic asthma.

Twenty-nine asthmatic children were studied to assess their ability to detect the severity of their bronchoconstriction. First (STEP 0): each child was asked if he "felt asthma," inviting him to give a self-estimated obstruction score (SEOS) from 0 (no asthma) to 3 (severe asthma) and a baseline FEV1 was recorded. Then (STEP 1): methacholine was administered to all except 9 children with an FEV1 less than 80% of predicted who received saline nebulization and a second SEOS was recorded. Finally: salbutamol aerosol was administered and a third SEOS and FEV1 were obtained (STEP 2). Spearman's correlation coefficients r between SEOS and FEV1 were for the overall population -0.602, -0.517, and -0.104 at STEP 0, STEP 1, and STEP 2, respectively. The r values reduction during the trial can be due either to a decrease of children's concentration during the study or to a real difficulty in recognizing repeated changes in airway status. Some children tend to underestimate their bronchospasm. For these patients an accurate assessment of the severity of the bronchoconstriction requires an objective measurement during acute changes in asthmatic children.

Asthma and the use of CNS depressants: gender differences.

A retrospective 5-year random sample of 196 charts of patients with asthma was obtained from two hospital-based outpatient clinics. The chart reviews showed that age- and severity-matched males and females with asthma were prescribed antihistamines in similar proportions; however, 16.8% of the females were prescribed a tranquilizer or sedative compared with 8.5% of the males. The females (8.7%) also were prescribed a combination of these drugs, or two tranquilizers; none of the males were prescribed more than one CNS depressant. Results showed that, in this study, females were prescribed CNS depressants three times as often as males.

Methylxanthines and fibrocystic breast disease: a study of correlations.

Daily methylxanthine ingestion from drug and dietary sources was studied by means of questionnaires from a sample of 102 women who visited the office of a radiologist for xeromammograms. The mammograms were used to measure the level of fibrocystic breast disease. Fibrocystic breast disease was found to be positively correlated with both caffeine and total methylxanthine ingestion. These positive findings are discussed in light of the fact that most recent studies of this link have been negative.

A reinterpretation of psychologically induced airways changes.

Psychologically induced airways changes in asthmatic individuals may be a function of variation in general activation level, not variation in asthma severity. The evidence for this hypothesis derives from work showing that healthy individuals exhibit psychologically induced airways changes similar to those exhibited by asthmatics. Individuals from both normal and healthy populations display increases in bronchomotor tone in response to stress and decreases in bronchomotor tone in response to relaxing stimulation. Although these responses are not limited to asthmatics, they are not irrelevant to asthma. Knowledge of specific relationships between airways changes and psychological factors is helpful in the management of asthma.

Controlled studies of childhood asthma self-management in Italy using the "open airways" and "living with asthma" programs: a preliminary report.

The concept of self-management for childhood asthma was introduced to Italy through a scientific exchange agreement with the United States. Two self-management programs, Living with Asthma (LWA) and Open Airways (OA), are being evaluated in three studies, two of which (Pilot and Atri-Viterbo) were conducted by the Respiratory Service of the Pediatric Department of the University "La Sapienza" in Rome and one by 14 Italian university pediatric respiratory centers (Project Italia). In October 1985, 20 children and their 40 parents were enrolled in the Pilot Study. One hundred percent of the mothers and children and 70% of the fathers attended all of the sessions. Theoretical knowledge about asthma and knowledge of asthma self-management behavior were assessed three times by a questionnaire: at the beginning of the program, at the end of the program and one year later. Significant improvements in knowledge of asthma and in knowledge of asthma self-management behavior were demonstrated by both parents and children at the end of the program and one year later. Analysis of clinical symptoms and drug consumption indicated a statistically nonsignificant trend towards a reduction of asthma severity in the year after the program. In the Atri-Viterbo study 8229 children were initially screened by a questionnaire. One hundred eighty-two children with asthma (2.4%) were identified and invited to participate in a self-management program. Open Airways was used in a shortened version. Only 29 families in Atri (22% of the eligible families) and 24 families in Viterbo (50%) ultimately agreed to participate in the program. A comparison of these families with those who did not participate showed that higher social status (p less than 0.001) and more severe asthma (p less than 0.05) were significantly associated with participation. Attendance by mothers and children was 78% in Atri and 61% in Viterbo. Only 5% of the fathers regularly attended the program. Parents who received the program registered a statistically significant increase in knowledge of asthma and knowledge of asthma self-management behavior relative to controls (+13% versus -4%; p less than 0.05). Fourteen university-based pediatric respiratory centers participated in Project Italia, in which the LWA and OA programs were compared in both full length and shortened versions (8 versus 4 h). Four hundred children and their families were enrolled in the study.(ABSTRACT TRUNCATED AT 400 WORDS)

Asthma deaths: are they preventable?

Asthma deaths have increased 11% between 1979 and 1982. Asthma is not a terminal condition; therefore, by definition, many of these deaths are preventable. A literature survey indicates the major causes of death from asthma to be four: 1) delays in getting/receiving appropriate care, 2) medication misuse, underuse, overuse, interaction and toxic effects, 3) receiving inappropriate care: sedation, insufficient corticosteroids, and 4) other risk factors: nocturnal asthma/morning dippers, labile and hyperresponsive airways, and infection among others. Several possible preventive measures are discussed.

Theophylline and fibrocystic breast disease.

After literature reports linking fibrocystic breast disease (FBD) to methylxanthine ingestion, a pilot study was undertaken to investigate the possible contribution of theophylline to this effect. The major goal of this project was to measure the effect of theophylline therapy on FBD in asthmatic women. All women attending an allergy clinic or an obstetrics/gynecology clinic over a 9-month period were examined to clinically assess FBD and were asked to complete a detailed questionnaire covering health history, other risk factors, and drug and dietary methylxanthines. The sample included 62 asthmatic women, 66 allergic but not asthmatic women, and 72 nonallergic and nonasthmatic women. By use of the FBD clinical taxonomy with its 19-point scale going from 0 to 18 that was developed for this study, the three groups did not differ significantly in terms of mean severity of FBD. On analyzing the effect of each of the methylxanthines on FBD severity, there is clear evidence that total methylxanthines was a contributing factor in FBD severity with or without adjustment for relevant variables, such as age, menopause, pregnancies, and groups. Theophylline was significant only when adjustments were made for age, pregnancy, and menopause in contrast to caffeine that was only significant with no adjustments.

Psychosocial mediators of abstinence, relapse, and continued smoking: a one-year follow-up of a minimal intervention.

This study investigates the relationship of health locus of control, health beliefs, social support, use of nonsmoking areas, and objecting to another person's smoking to long-term abstinence and relapse following a minimal intervention for smoking cessation. Subjects participated in a single session group hypnosis treatment for smoking cessation. Questionnaires were completed by participants pretreatment and at a 1-year follow-up. Ex-smoker, recidivist, and continuing smoker groups were defined using follow-up data from 219 participants (70 males and 149 females). The data were analyzed using univariate and multiple discriminant analysis techniques. The results show that the three smoking status groups could be discriminated. Ex-smokers actively coped with smokers in their environment, avoided other smokers in public places, and received considerable support from spouses and friends. In contrast, recidivists prior to treatment had been unable to quit smoking for extended periods of time and placed greater responsibility on powerful others for their health. Following treatment, recidivists did not actively cope with smokers, were more likely to participate in additional hypnosis, and placed less responsibility on either powerful others or themselves for their own health. It was concluded that posttreatment factors appear to be more important for long-term maintenance of nonsmoking than entry characteristics of participants. Recommendations include incorporation of coping skills training into cessation programs and restrictions on smoking in the ex-smokers' environments to prevent relapse.

Evaluation of a family asthma program.

This article presents the results of an evaluation of a 12-hour patient education program for children with asthma and their parents. Ninety-two of 147 participants (63%) completed the 1-year follow-up. The effectiveness of the family asthma program (FAP) was measured by a "knowledge of asthma" questionnaire administered before and at the last session; it demonstrated a significant improvement for parents (p less than 0.001) and children (p less than 0.01). The "multidimensional health locus of control scales" (administered to a subgroup of 42 adults and 29 children before and 3 mo after the FAP) demonstrated a significant change in attitude toward asthma for both parents (p less than 0.05) and children (p less than 0.005), indicating an interest to assume more responsibility for self-management. In addition, eight variables were measured in the children before the FAP was started and longitudinally on a monthly basis for 1 yr after completion of the FAP. Three of these variables demonstrated a significant change: total activities were increased (p less than 0.001), unscheduled health-care visits were decreased (p less than 0.005), and school absences were decreased (p less than 0.005). Four variables did not reach statistical significance but did change in the expected direction: medication score, 10% decrease; emergency treatments, 24% decrease; hospital admissions, 44% decrease; school activities, 5% increase. These results demonstrate that this FAP effectively complemented medical care and provided a useful preparation for self-management.

Implementation of the school nurse practitioner role: barriers and facilitators.

The purpose of this descriptive pilot study was to begin an exploration of the role determinants that facilitate or cause barriers to the implementation of the school nurse practitioner (SNP) role. Utilizing a two-step design, 16 SNPs from different school districts were surveyed to determine if their assignment included doing school physical exams. Thirteen indicated that they were functioning as SNPs. The three "no" districts were matched with three of the "yes" districts. An SNP, a school health administrator and a school physician from each district were interviewed individually using a structured questionnaire. The focus of the questions was on organizational structure of the school health services, indicators of administrative support for SNPs and the assigned function of the SNP. Responses were matched for the "yes" and "no" districts and for the three types of professionals. The major facilitator of SNP role implementation was if the idea had originated with the administrator or physician decision maker. Role change and boundary encroachment were the main barriers identified.